MedPage Today (11/8, Susman ) reports, “Babies of mothers who have unhealthy obesity (that is, obesity along with other metabolic comorbidities) appear to have greater levels of adiposity when compared with the offspring of women with metabolically healthy obesity, researchers reported.” The findings were presented at the ObesityWeek virtual meeting and simultaneously published in Obesity.”
This came across my medical news feed today. It’s hard to believe that medicine continues to struggle so much with the concept of metabolic dysfunction. We have moved from bad to much worse. What on earth is healthy obesity?? An Oxymoron to describe people who are obese but without other health problems such as hypertension, hyperlipidemia, diabetes, etc.
After just practicing medicine and observing metabolic disease over the last 20 years, it is obvious that people with insulin resistance and metabolic dysfunction start their disease process at birth when they start life with too much fat and move through life in stages of chronic disease. Stage I or pre-diabetic phase is characterized by increasing weight, normal to low blood sugars, and no other “chronic metabolic diseases,” defined in this article as healthy obesity? This passing stage however gives way in virtually all patients to stage II, called borderline diabetes or glucose intolerance.
About 25% of the medical system is now recognizing this as a problem but still giving advice like, “watch your weight and exercise more.” A modest amount of these patients are having other disease manifestations besides obesity and would be now called “unhealthy obesity.” Phase 3 is now frank diabetes by anyone’s definition and jumped on by the medical system with a drug regimen frenzy to lower blood sugar, still rarely with any significant nutritional support other than the food pyramid or “try to cut carbs,” neither of which makes a significant change in health overall. Lastly, stage 4, insulin-requiring which I call the point of no return, whereby life can only be sustained by insulin injection.
So to deem stage one of a 4 stage disease process as somehow being “healthy” is simply pushing the slow advancements in this area backward 100 steps. It makes perfect sense that the metabolic system of patients in stage 1 is far better than those of stage 3 for example. Therefore it makes perfect sense that babies born from those mothers are going to be somewhat less affected (notice I didn’t say healthier) on the surface than those born from a stage 3 mother.
As physicians, we need to stop the psychological tendency to pronounce people normal or healthy when they are not. When the blood pressure exceeds a threshold we call that hypertension (not healthy) and when blood sugar is up, diabetes (not healthy), so why when BMI is in the overweight range 25+ – 30, or 30+, obesity, why can we pass that as somehow “healthy.” Where is the disconnect? The accumulation of excess fat is a clear sign of metabolic dysfunction and Insulin resistance and patients with this issue go on to manifest all the other chronic metabolic diseases.
Different individuals progress at different rates depending on their level underlying metabolic derangement and ultimately driven by their lifetime carbohydrate exposure and amplified by physiologic stress factors along the way. I would argue that both groups of patients described as obese are Unhealthy, simply at different stages in the same disease.